HomeMy WebLinkAboutBLD1990-00686 • , 76-a,,aiLfillt Pn, Pg 8V5-7
, .. , - BUILDING 'ERMIT APPLICATION
Jefferson County Building Department'P .O . Box 1220'Port Townsend . WA 98368
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SPECIFIC LOCATI�7N SITE ADDRESS /.
POSTAL DISTRICT /Sl9BD I S I ON
LEGAL DESCRIPTION LOT
7 BLOCK DIVISION TAX NUMBER
PARCEL NUM ER �.3IC'-r� L ) 7 1 / 4 SECTION
PLANNING AREA
SECTION /O TOWNSHIP a U NORTH RANGE I'I W//JJ / �n �Q /�j
BUILDING INFORMATION 4'" NGfti p1 1-r �J6lti 64f C o
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE F�f77OTAGE/g ✓�
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR J
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR ' 0 00
GARAGE ❑ REPLACEMENT
GARAGE T 7
O WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES / f35 � �
❑ COMMERCIAL SIZE /ccRvi a.
❑ INDUSTRIAL YEAR 0 a ; 1 8 ya,
O HOTEL/MOTEL/DORMITORY MAKE (OOVJ a $ 8 OC I✓/'
NUMBER OF UNITS 3 `�,f W, a ;e �-
❑ OTHER - SPECIFY ESTIMATED COST O.F /
IMPROVEMENTS TOTAL FA MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
XWOOD FRAME J ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED /❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
y //
❑ REINFORCED CONCRETE
❑ OIL A OTHER - SPECIFY /
❑ MASONRY ( WALL BEARING ) DIMENSIONS❑ OTHER - NUMBER OF STORIES / TOTAL LAND AREAQ
U/!
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
/ iit PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS '
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATI-Irroom>7 Y4,
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF/I EXISTING' IBA/TFJRO�O-MMf�'
ATER
LY
PUD TYPE OF)4 PUBLICN'( NAMESOFPWATER SUPPLY) L.-�i��l��/ l�`�""le e
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
X NO
APPROVED DATE BANK HEIGHT SETBACK
11
PUBLIC WORKS DEPT ROAD RIGHT-OF - WAY WIDTH , f /
NAME OF PUBLIC ROAD .
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
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NAME MAILING ADDRESS ZIP TEL NO
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ARCH f r
SHE O►INER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LABS.
SIGN TURF OF ICANT APPLI ATION ATE - RECEIPT NUMBER ( CHECK NUMBER OR CASH
(C:71'ram -2-7 7 ' .
APPROVED BY ERMIT -EE9
•C 0 BASE FEE INSPECTION
✓ -. •o BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE / TOTAL
9 I I NUMBER REI-uIID DATE DATh ISSUED
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